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Changing indications in liver transplantation

M Webberley1, J Neuberger

  • 1Queen Elizabeth Hospital, Birmingham, UK.

Bailliere'S Clinical Gastroenterology
|September 1, 1994
PubMed
Summary

Orthotopic liver transplantation now offers over 90% survival, but selecting optimal timing and recipients for liver replacement remains challenging. Research explores alternatives and improving indications while minimizing immunosuppression side effects.

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Area of Science:

  • Hepatology
  • Transplantation Medicine
  • Immunosuppression

Background:

  • Orthotopic liver transplantation (OLT) has evolved into a routine procedure with high 1-year survival rates (>90%) in elective cases.
  • Increasing experience has shifted focus towards refining OLT indications and determining optimal procedural timing.
  • Challenges persist in selecting patients with fulminant hepatic failure for timely transplantation before irreversible complications arise.

Purpose of the Study:

  • To review advancements in liver transplantation, including indications and timing.
  • To assess alternative strategies to OLT.
  • To highlight ongoing efforts in managing long-term sequelae and reducing immunosuppression.

Main Methods:

  • Review of current practices and outcomes in orthotopic liver transplantation.
  • Assessment of emerging alternative liver support and transplantation methods (heterotopic, partial OLT, xenografting).
  • Analysis of progress in patient selection for viral hepatitis and alcoholic liver disease.

Main Results:

  • High survival rates achieved in elective OLT cases.
  • Difficulties remain in timely organ allocation for fulminant hepatic failure.
  • Progress noted in indications for viral hepatitis and alcoholic liver disease.
  • Long-term immunosuppression sequelae necessitate strategies for reduction.

Conclusions:

  • Liver transplantation is a successful treatment but prevention of end-stage liver disease is paramount.
  • Ongoing research focuses on optimizing patient selection, exploring alternatives, and mitigating immunosuppression's long-term effects.
  • Further advancements are needed to improve outcomes and reduce the burden of immunosuppressive therapy in liver transplant recipients.

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